Black Americans and single mothers disproportionately affected by states refusing to expand Medicaid

A New York Times analysis has found that the Affordable Care Act, the landmark health care reform legislation, will leave out two thirds of poor black folks and single mothers, and more than half of uninsured low-wage workers:

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

In short, because the very states that hold a disproportionate amount of low-income folks are also the majority of the states that have rejected the Medicaid expansion, low-income folks there are going to be left in an uneasy limbo: required by law to get coverage, but unable to qualify for subsidies because, as the law was originally written, they were meant to be covered by an expanded Medicaid program.

As it stands currently, it is incredibly difficult to qualify for Medicaid in many states. “You got to be almost dead before you can get Medicaid in Mississippi,” said Willie Charles Carter, and this is not too far from the truth in many other states.

Black Americans are disproportionately affected, the analysis found; 6 out of 10 black folks live in states that are not expanding Medicaid. While these states make up about half of the country’s population, 68% of poor, uninsured black folks and single mothers live there. This is of course, to say nothing of the folks who never did qualify, such as undocumented immigrants.

The health care law is very far from perfect, and savvy advocates have known very well that the most vulnerable folks were going to fall through the cracks; after all, when you make health care something folks have to pay for, there will always be some who will be unable to do so. But because of the Supreme Court decision that allowed states to choose whether they would expand Medicaid or not, those cracks are a lot bigger than many of us expected. Meanwhile, a few rogue tea-party Republicans have shut down the government – halting the paychecks of countless government workers while they themselves are getting paid quite nicely – to ensure that the benefits of this Republican-designed health care reform (let’s not forget it was modeled after what Mitt Romney did in Massachusetts) are reaped by nobody.

New York, NY

Verónica Bayetti Flores has spent the last years of her life living and breathing reproductive justice. She has led national policy and movement building work on the intersections of immigrants' rights, health care access, young parenthood, and LGBTQ liberation, and has worked to increase access to contraception and abortion, fought for paid sick leave, and demanded access to safe public space for queer youth of color. In 2008 Verónica obtained her Master’s degree in the Sexuality and Health program at Columbia University’s Mailman School of Public Health. She loves cooking, making art, listening to music, and thinking about the ways art forms traditionally seen as feminine are valued and devalued. In addition to writing for Feministing, she is currently spending most of her time doing policy work to reduce the harms of LGBTQ youth of color's interactions with the police and making sure abortion care is accessible to all regardless of their income.

Verónica is a queer immigrant writer, activist, and rabble-rouser.

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